KEMAS 18 (4) (2023) 473-482

Jurnal Kesehatan Masyarakat

http://journal.unnes.ac.id/nju/index.php/kemas

Types and Sources of Antioxidants that Role in Determining Fertility Level

Sri Winarni1, Ari Udijono2, Atik Mawarni1, Dharminto1, Oktavia Beni Kujariningrum1,
Waviq Azizah2
1Biostatistics and Population, Faculty of Public Health, Diponegoro University
2Epidemiology and Tropical Diseases, Faculty of Public Health, Diponegoro University

Article Info Abstract

Article History:
Submitted September 2022
Accepted January 2023
Published April 2023
Keywords:
pre-testing, COVID-19
source of antioxidants, male
fertility, female fertility, ROS
DOI
https://doi.org/10.15294/
kemas.v18i4.39261
Lifestyle and exposure to free radicals affect a person’s fertility. ROS (Reactive Oxygen
Species) in excess can cause oxidative stress and DNA damage (deoxyribonucleic acid).
Adequate intake of antioxidants is needed to maintain ROS levels. This review aims to
determine the types and sources of antioxidants that play a role in determining a per-
son’s fertility level. This research is a narrative review by a literature review method by
collecting and concluding data from previous studies. The search for research articles
was carried out on Scopus, Science Direct, Clinical Key, SpringerLink, BMC, and Google
Schoolar portals with keywords foodstuffs, antioxidants, and infertility which found
8,745 articles. A total of 75 articles met the inclusion-exclusion criteria for use in writing
this article. The research took time in 2022. Most antioxidants take a role in determining
male fertility, such as glutathione, selenium, carotenoids (beta-cryptoxanthin, lycopene,
beta-carotene, and lutein), zinc, vitamin C, vitamin E, and flavonoids. NAM (Nicotina-
mide) and carvacrol play a role in determining female fertility. These antioxidants can
be found in fruits, vegetables, protein sources, and several other plants. Consumption of
antioxidant sources is highly recommended to increase fertility, especially for infertile
couples.

Introduction Lifestyle factors have a role in determining

Infertility has the potential to affect
various aspects of a person’s life, including
physical, mental, social health, and overall
quality of life (Bakhtiyar et al., 2019). Cognitive
reactions and emotional-affective reactions
to infertility conditions and the therapeutic
process are often experienced by infertile
patients (Hasanpoor-Azghdy et al., 2014). As
many as 22.3% of infertile patients had stress,
with fatigue being the main complaint (38.1%).
The duration of infertility showed a significant
relationship with the level of stress experienced
by the patient (p < 0.05) (Wiweko et al., 2017).
High-stress levels allow a person to have
infertility three times OR=3,89; CI 95%=1,04 to
14,46; p=0,046) (Indarwati et al., 2017).
a person’s fertility (Acharya and Gowda, 2017).
Long-term exposure to chemicals, such as
pesticides, fertilizers, and industrial products
(plasticizers and phytoestrogens) has been
associated with decreased fertility through
hormonal pathways (Ding et al., 2016). Free
radicals had a physiological role in optimizing
sperm performance (Palmieri et al., 2016).
Excessive amounts of ROS (reactive oxygen
species) can cause oxidative stress and then
DNA damage (Cleaver et al., 2014). Nearly 10%
of infertile/subfertile women are identified with
DOR (Decreased Ovarian Reserve) (Pastore et
al., 2014).
The quality of the diet was related to
energy and nutritional sufficiency (Mardiana


Correspondence Address: pISSN 1858-1196
Biostatistics and Population, Faculty of Public Health, Diponegoro University, Indonesia. eISSN 2355-3596
Email : winarni@live.undip.ac.id

et al., 2022). Previous research had shown that
healthy food intake is associated with sperm
and semen quality (Efrat et al., 2018). Adequate
intake of antioxidants is needed to maintain
ROS levels (Liu et al., 2018). Antioxidants are
compounds capable to stop the chain reaction
of the oxidative stress process by capturing free
radicals (Ko et al., 2014). Antioxidants act as
free radical reducers, enhancing endogenous
antioxidant defense systems and oxidative
stress-induced gene expression (Bai et al., 2016).
Antioxidant levels were significantly related to
sperm concentration and count of total motile.
The higher of antioxidant levels in a body, the
higher the sperm concentration and total motile
count (Silberstein et al., 2016). Antioxidant
therapy often consumed by patients is vitamin
C, vitamin E, minerals (selenium and zinc)
(Bardaweel, 2014). This study will combine the
results of various previous studies to know the
types and sources of antioxidants that play a
role in determining a person’s fertility level.
FIGURE 1. Article Selection Flowchart
KEMAS 18 (4) (2023) 473-482
Method
This Research is a narrative review using
the literature review method by collecting and
concluding data from previous studies. The
research was conducted in April-May 2022.
The search for previous research articles was
carried out on Scopus, Science Direct, Clinical
Key, SpringerLink, BMC, and Google Schoolar
portals with keywords in the form of foodstuffs,
antioxidants, and infertility. The evaluation of
the articles was carried out according to the
inclusion and exclusion criteria of the previous
articles. Inclusion criteria were research
articles on the role of antioxidants in fertility
enhancement, that can be accessed on indexed
international journal portals or national
journal portals which are minimum accredited
in SINTA 2, published in 2013-2022, and was
an original article. The exclusion criteria are
an article that can be accessed in abstracts and
proceedings only.
474
Sri Winarni, et all. / Types and Sources of Antioxidants that Role in Determining Fertility Level

A total of 584 out of 8,745 articles portal, 2 articles on the BMC journal portal,
discussed the role of antioxidants in fertility and 9 articles on the Google Schoolar with
enhancement were published from 2013-2022. minimum accredited in SINTA 2.
A total of 206 are original can be accessed
on indexed international or national journal Result and Discussion
portals that are, minimum accredited in SINTA Antioxidants have an important role in
2. A total of 131 articles can only be accessed determining a person’s fertility. Most of the
in abstract form. A total of 75 articles met antioxidants that play a role in determining male
the inclusion and exclusion criteria, so they fertility. These antioxidants include glutathione,
were used in writing this narrative review that selenium, carotenoids (beta-cryptoxanthin,
consisting of 20 articles on the Scopus journal lycopene, beta-carotene and lutein), zinc,
portal, 25 articles on the Science Direct journal vitamin C, vitamin E, and flavonoids. NAM
portal, 10 articles on the Clinical Key journal and carvacrol play a role in determining female
portal, 9 articles on the SpingerLink journal fertility.
TABLE 1. Types of Antioxidants that Play a Role in Determining a Person’s Fertility
Types of Antioxidants Role Referensi
NAM NAM is positively correlated with the rate of (Guo et al., 2022)
maturation and fertilization of mouse oocytes
Glutamine Glutamine prevents decreased sperm quality, reduces (Afolabi et al., 2022)
oxidative stress, inflammation and apoptosis
Carvacrol Carvacrol is useful in the treatment of ovarian (Sahin et al., 2022)
ischemia-reperfusion injury and infertility
β-cryptoxanthin β-cryptoxanthin has a positive effect on sperm (Haeri et al., 2022)
motility
Lycopene Lycopene can protect sperm from oxidative stress and (Babaei et al., 2021)
damage to sperm DNA
There is a positive relationship between lycopene (Zareba et al., 2013)
intake and sperm morphology
Selenium Selenium can increase semen volume and total sperm (Talebi et al., 2021)
motility
Zinc The effect of zinc supplementation through the (Shahraki et al., 2015)
pretesticular pathway can increase serum FSH, LH,
and testosterone
Vitamin C Vitamin C can improve the motility and morphology (Cyrus et al., 2015)
of spermatozoa
Vitamin E Vitamin E is able to repair oxidizing radicals directly (Yan et al., 2014)
and prevent the process of lipid peroxidation
Beta-Carotene There is a relationship between beta-carotene intake (Talebi et al., 2021)
and sperm motility
Lutein There is a relationship between lutein intake with (Zareba et al., 2013)
sperm motility and normal sperm morphology
Flavonoids Flavonoids can promote hydrogen ions, so they (Jamalan et al., 2016)
can neutralize the toxic effects of these free radicals
and increase motility and morphology of normal
spermatozoa.

Source : Primary Data. 2022

Antioxidants that play a role in deter-
mining a person’s fertility can be found in
foodstuffs in the form of fruits, vegetables,
and protein sources. The fruits in question
include watermelon, tomatoes, mango, and
kiwi. The vegetables in question include banana
blossoms, bamboo shoots, purple carrots, and
parsley. Sources of protein in question include
legumes, bay shellfish, meat and eel. In addition,
antioxidants that play a role in determining a
person’s fertility are also found in male date
flowers, mulberry leaves, sour soup leaves, and
green algae.

475
 KEMAS 18 (4) (2023) 473-482

TABLE 2. Source of Antioxidants

Source of Antioxidants Types of Antioxidants Reference
Banana Blooms Phenolic (Panyayong and Srikaeo, 2022)
Bamboo Shoots Fenol, Flavonoids, Vitamin C (Singhal et al., 2021)
Spinach Peptide (Fillería et al., 2021)
Pod Polyphenol, Flavonoids, Saponins, (Asati et al., 2022)
isoflavonoid
Purple Carrots Flavonoids (Perez et al., 2022)
Soya bean Isoflavonoiddan peptide (Tkaczewska et al., 2022)
Male Date Flower Polyphenol, flavonoids .(Karra et al., 2020
Parsley Phenolic acid, Flavones, Flavonoid, dan (Ferreira et al., 2022)
Carotenoids
Sorghum seeds Phenolic (Miafo et al., 2022)
Mulberry leaf Phenolic acid, flavonoids, dan alkaloids (Polumackanycz et al., 2021)
Soursop leaf Flavonoids, chlorogenic acid (Leal et al., 2022)
Green algae Phenolic, flavonoids, Vitamin C, Vitamin (S et al., 2022)
D, dan Ferron
Tamarind Papain Hydrolyzate (Bagul et al., 2018)
Purple Head Broccoli Isothiocyanates (Chaudhary et al., 2018)
Watermelon Lycopene (Mahamat et al., 2021)
Tomatoes carotenoids, lycopene, β-carotene, (de Souza et al., 2021)
flavonoids, and anthocyanins
Mango phenolic, glutathione, thiobarbituric (Zapata-Londoño et al., 2020)
acid reactive substances (TBARS), and
8-hydroxydeoxyguanosine
Gulf shell Selenium (Zhang and Yang, 2014)
Se-methyl-seleno-cysteine
(MeSeCys
Kiwi Polyphenol, flavonoids, flavanol, tannins, (Leontowicz et al., 2016)
vitamin C, lutein, zeaxanthin and fiber
Meat Meat contains protein, ferron, vitamin (Pereira and Vicente, 2013)
B12 and other B-complex vitamins, zinc,
selenium and phosphorus.
Eel The moisture, protein, carbohydrate, fat, (Wijayanti and Setiyorini,
ash, vitamin A and vitamin E 2018)
Mushroom Vitamin B3, nicotinic acid, nicotinamide (Çat and Yaman, 2019)

Source : Primary Data. 2022

Glutathione is a natural antioxidant
consisting of three amino acids. Namely
cycteine, glutamine, and glycine ( Adeoye et
al., 2018). Glutathione prevented the formation
of free oxygen due to the reconstruction of the
thiol group (-SH)(Palani, 2018). Glutamine is
an amino acid that forms glutathione, prevent
a decrease in sperm quality, and reduce
oxidative stress, inflammation, and apoptosis
(Afolabi et al., 2022). Glutamine prevents NF-
kB activation, thereby decreasing transcription
of downstream pro-inflammatory genes,
preventing cytokine storms, and DNA damage
(Hamed et al., 2022). Glutathione plays a role
in the maintenance of the thiol redox status
of a cell, protection against oxidative damage,
endogenous and exogenous detoxification of
reactive metals and electrophiles, storage and
transport of cysteine, as well as for protein
and DNA synthesis, cell cycle regulation, and
cell differentiation. A reduced glutathione
system causes cytotoxic and destructive
lesions (Fafula et al., 2017). Consumption of
glutathione food sources is considered capable
of maintaining sperm quality. Mango fruit
contains glutathione, phenolic, TBARS, and
8-hydroxydeoxyguanosine. Daily consumption
of mango juice (cv. Azúcar) increases the
antioxidant capacity of plasma (Zapata-
Londoño et al., 2020).

476
Sri Winarni, et all. / Types and Sources of Antioxidants that Role in Determining Fertility Level
Selenium is vital in growth, immunity,
reproductive system, and endogenous
antioxidant system support (McLaughlin and
Gunderson, 2022). Selenium can increase
semen volume and total sperm motility (Talebi
et al., 2021). Selenium modulates DNA repair
and suppresses testicular toxicity through free
radical targeting. Selenium supplementation
has been shown to reduce the toxicity of non-
steroidal anti-inflammatory drugs in rat testes
(Sharma et al., 2020). A higher level of seminal
selenium is associated with live births and a
higher chance of pregnancy (Wu et al., 2020).
Consumption of selenium food sources, such
as meat and bay shellfish, is recommended to
improve the quality of spermatozoa, especially
for infertile couples. Meat and shellfish are
proven to contain selenium (Pereira and
Vicente, 2013; Zhang and Yang, 2014).
Carotenoids are bioactive compounds
found in many fruits and vegetables. Caro-
tenoids had many types of pigments. Beta-
cryptoxanthin is a yellow pigment in the
carotenoid pro-vitamin A. Beta-cryptoxanthin
has antioxidant properties proven to fight free
radicals (Brahma and Dutta, 2022). The ability to
fight free radicals can reduce ROS, so it positively
affects the percentage of sperm motility (Haeri
et al., 2022). Lycopene is a red pigment in
carotenoids. Lycopene intake is associated
with normal spermatozoa morphology. The
percentage of morphologically normal sperm
among men in the highest quartile of lycopene
intake was 1.7 percent higher than among men
in the lowest quartile (Zareba et al., 2013).
Lycopene can protect sperm from oxidative
stress and damage to sperm DNA (Babaei
et al., 2021). Beta-Carotene is a red-orange
pigment in carotenoids. Beta-carotene acts
as a potent oxidative stress mitigation agent
and can modulate oxidative stress through
the regulation of ROS turnover (Nishino et
al., 2017). Beta-carotene intake is positively
related to sperm motility (Zareba et al., 2013).
Lutein is a natural carotenoid containing many
unsaturated double bonds, which can prevent
free radicals and can produce an antioxidant
effect (Zhao et al., 2022). Lutein intake is
related to sperm motility. Men with high
lutein intake had a 4.4 higher percentage of
progressive motility than men with low lutein
477
intake (Zareba et al., 2013). Lutein reversed
vascular endothelial dysfunction, significantly
upregulated the mRNA and protein expression
of SOD2 and GPx1, and down regulated the
expression of NF-κB p65 and ICAM-1 (Wang
et al., 2014).
Consumed carotenoid sources are
recommended to increase the antioxidant
capacity in the body, so that it can increase
the percentage of sperm motility and normal
sperm morphology. Tomato is a fruit rich in
antioxidants. Tomatoes contain carotenoids,
lycopene, β-carotene, flavonoids, and antho-
cyanins (de Souza et al., 2021). Parsley also
contains carotenoids (Ferreira et al., 2022).
Lycopene can be found in watermelon, which
is 10.46 to 42.83 mg.kg-1 watermelon extract
(Mahamat et al., 2021). Kiwi fruit contains
Lutein (Leontowicz et al., 2016).
Zinc is a mineral needed by every
cell in the body, including the reproductive
organs. Zinc deficiency causes spermatozoa
abnormalities, such as fibrous sheath hyper-
trophy and hyperplasia, axonema disorders,
and an abnormal midpiece(Majzoub and
Agarwal, 2017). Zinc increases total antioxidant
activity (serum SOD/Superoxide Dismutase
and -tocopherol)(Omu et al., 2015). The results
of another study, zinc supplementation for
12 weeks showed an increase in the average
number of spermatozoa: 14.83 million/mL
(p-value < 0.01), spermatozoa motility 16.30%
(p-value < 0.01), motility fast spermatozoa
11.96% (p-value < 0.01), and spermatozoa
morphology: 4.26% (p-value < 0.001) (Fatima
et al., 2015). In the pretesticular pathway, zinc
can increase serum FSH, LH, and testosterone
(Shahraki et al., 2015). Zinc played a role
in the amelioration of gonadal dysfunction
and decreased oxidative stress in the testes
(Mohamad and Hassan, 2014). Zinc modulates
the activity of Ca2+, ATPase enzymes and
reduces anti-sperm antibodies, specifically
Immunoglobulin G (IgG) (Zhao et al., 2016).
In the testicular pathway, zinc maintains
chromatin stabilization, repairs DNA damage,
and plays a role in DNA transcription and
translation (Zhao et al., 2016). In the post-
testicular pathway, zinc regulate the growth
and apoptosis of prostate epithelial cells so
that the prostate can function optimally in

increasing semen volume (Zhao et al., 2016).
The consumption of foods containing zinc can
be an alternative to taking zinc supplements to
improve sperm quality. Meat is one of the zinc
sources (Pereira and Vicente, 2013). Besides
that, meat is also rich in protein, iron, vitamin
B12, other B-complex vitamins, selenium, and
phosphor (Pereira and Vicente, 2013).
Vitamin C, or ascorbic acid, is an anti-
oxidant with the fewest side effects (da Cruz et
al., 2018). Vitamin C can improve the motility
and morphology of spermatozoa (Cyrus et
al., 2015). Vitamin C neutralizes free radicals,
so it can prevent and/or reduce the presence
of ROS (Agarwal et al., 2014). Vitamin C is
able to captured hydroxyl free radicals by
donating a single electron (Zhao et al., 2013).
Vegetables and fruits serve as natural sources of
vitamin C intake. Vitamin C is found in kiwi
fruit (Leontowicz et al., 2016), bamboo shoots
(Singhal et al., 2021), and green algae (S et al.,
2022).
Vitamin E is a fat-soluble antioxidant.
Vitamin E can repair oxidizing radicals directly
and prevent the process of lipid peroxidation
(Yan et al., 2014). Spermatozoa DNA fragmen-
tation can be reduced by taking vitamin E,
thus increases the morphology of normal
spermatozoa(Egwurugwu et al., 2013). Vitamin
E can increase semen volume and sperm motility
(Muhammad, 2017). Malondialdehyde (MDA)
levels decreased significantly in the vitamin C
and E. supplementation groups. MDA levels are
markers of oxidative stress. Decreased MDA
levels is along with decreased oxidative stress
(Rusiani et al., 2019). Consumption of sources
of vitamin E is recommended, especially for
individuals who had oxidative stress. One
source of vitamin E is eel. Vitamin E content of
the wild eel was 0.21%, and 0.224% of cultural
eel (Wijayanti and Setiyorini, 2018).
Flavonoids are one of a compounds group.
It can be used as anticancer, antidepressant, and
antioxidant. Flavonoids can be found in plant
extracts (Mouradov and Spangenberg, 2014).
Flavonoids can neutralize the toxic effects of free
radicals because they can encourage hydrogen
ions to increase the motility and morphology
of normal spermatozoa (Jamalan et al., 2016).
Flavonoids have a strong relationship with the
KEMAS 18 (4) (2023) 473-482
antioxidant test results and have a negative
relationship with the concentration of ROS
(Šola et al., 2018). Flavonoids-contain food is
considered positive on human health (Asati
et al., 2022). Parsley consumption can reduce
oxidized compounds that come from oxidative
processes (Ferreira et al., 2022). Beside parsley,
other food that contain flavonoid compounds,
such as bamboo shoots (Singhal et al., 2021),
pods (Asati et al., 2022), purple carrots (Perez
et al., 2022), mulberry leaves (Polumackanycz
et al., 2021), tomatoes (de Souza et al., 2021),
and kiwi (Leontowicz et al., 2016).
NAM or niacin or vitamin B3 is a type of B
vitamin that plays a role in enzymatic reactions
in carbohydrate, fat, and protein metabolism
formed from nicotinic acid and nicotinamide
(Çat and Yaman, 2019). Niacin can capture free
radicals and reduce ROS (El Sheikh et al., 2020).
The level of NAM in follicular fluid is associated
with the development of larger follicles, and
the level of niacin is also associated with the
oocyte maturation and fertilization rate (Guo
et al., 2022). Consumption of mushrooms can
contribute to the need for vitamin B3 as much
as 5.384 mg/100g, consisting of 66% nicotinic
acid and 34% nicotinamide (Çat and Yaman,
2019).
Phenol is one type of phenolic compound
with a simple group, which is beneficial for the
body because of its antioxidant properties that
can protect tissues from oxidative damage.
Carvacrol or also known as monoterpenoid
phenol, is a part of phenol that has high activity
as an antioxidant, increased antioxidant
defenses lead to increased immune system
response (Hashemipour et al., 2014). Carvacrol
has a positive impact on infertility treatment
because carvacrol plays a role in the treatment
of ischemia-reperfusion ovarian injury and
infertility (Sahin et al., 2022). Some plants
that contain carvacrol include banana blossom
(Panyayong and Srikaeo, 2022), bamboo shoots
(Singhal et al., 2021), pod(Asati et al., 2022),
male date flower(Karra et al., 2020), parsley
(Ferreira et al., 2022), sorghum seeds(Miafo
et al., 2022), mulberry leaf(Polumackanycz
et al., 2021), green algae(S et al., 2022),
mango(Zapata-Londoño et al., 2020) and kiwi
(Leontowicz et al., 2016).
478
Sri Winarni, et all. / Types and Sources of Antioxidants that Role in Determining Fertility Level
Conclusion
Antioxidants can increase fertility in
both men and women. Most antioxidants play
a role in improving sperm quality through the
ROS suppression. Antioxidants for increasing
male fertility include glutathione, selenium,
carotenoids (beta-cryptoxanthin, lycopene,
beta-carotene, and lutein), zinc, vitamin C,
vitamin E, and flavonoids. Only 2 antioxidants
play a role in determining female fertility in
this review, namely NAM and carvacrol. These
antioxidants can be found in several sources
antioxidants. Sources of antioxidants in the form
of fruit, namely watermelon, tomatoes, mango,
and kiwi. Sources of antioxidants in vegetables,
namely banana heart, bamboo shoots, purple
carrots, and parsley. Antioxidants are also
found in protein sources, including legumes,
bay scallops, meat, and eel. In addition to fruit,
vegetables, and protein sources, antioxidants
that play a role in determining a person’s
fertility are also found in male date flowers,
mulberry leaves, soursop leaves, and green
algae. Consumption of antioxidant sources
is recommended to increase fertility levels,
especially for infertile couples.
References
Acharya, S., & Gowda, C., 2017. Lifestyle Factors
Associated with Infertility in a Rural Area: A
Cross-Sectional Study. Int. J. Med. Sci. Public
Heal., 6, pp.502–506.
Adeoye, O., Olawumi, J., Opeyemi, A., & Christiania,
O., 2018. Review on the Role of Glutathione
on Oxidative Stress and Infertility. J. Bras.
Reprod. Assist., 22, pp.61–66.
Afolabi, O.A., Anyogu, D.C., Hamed, M.A., Odetayo,
A.F., Adeyemi, D.H., & Akhigbe, R.E., 2022.
Glutamine Prevents Upregulation of NF-
kB Signaling and Caspase 3 Activation in
Ischaemia/Reperfusion-Induced Testicular
Damage: An Animal Model. Biomed.
Pharmacother., 150, pp.113056.
Agarwal, A., Virk, G., Ong, C., & du Plessis, S.S.,
2014. Effect of Oxidative Stress on Male
Reproduction. World J. Mens. Health, 32(1).
Asati, V., Deepa, P.R., & Sharma, P.K., 2022. Desert
Legume Prosopis cineraria as a Novel Source
of Antioxidant Flavonoids/Isoflavonoids:
Biochemical Characterization of Edible Pods
for Potential Functional Food Development.
Biochem. Biophys. Reports, 29, pp.1–6.
Babaei, A., Asadpour, R., Mansouri, K., Sabrivand,
479
A., & Kazemi-Darabadi, S., 2021. Lycopene
Protects Sperm from Oxidative Stress in the
Experimental Varicocele Model. Food Sci.
Nutr., 9, pp.6806–6817.
Bagul, M.B., Sonawane, S.K., & Arya, S.S., 2018.
Bioactive Characteristics and Optimization
of Tamarind Seed Protein Hydrolysate
for Antioxidant-Rich Food Formulations.
Biotech, 8, pp.1–8.
Bai, K., Xu, W., Zhang, J., Kou, T., Niu, Y., Wan,
X., Zhang, L., Wang, C., & Wang, T., 2016.
Assessment of Free Radical Scavenging
Activity of Dimethylglycine Sodium Salt
and Its Role in Providing Protection Against
Lipopolysaccharide- Induced Oxidative
Stress in Mice. PLoS One, 11, pp.1–17.
Bakhtiyar, K., Beiranvand, R., Ardalan, A.,
Changaee, F., Almasian, M., Badrizadeh, A.,
Bastami, F., & Ebrahimzadeh, F., 2019. An
Investigation of the Effects of Infertility on
Women’s Quality of Life: A Case-Control
Study. BMC Womens. Health, 19, pp.1–9.
Bardaweel, S.K., 2014. Alternative and Antioxidant
Therapies Used by a Sample of Infertile Males
in Jordan: A cross-Sectional Survey. BMC
Complement. Altern. Med., 14, pp.1–8.
Brahma, D.,& Dutta, D., 2022. Antioxidant Property
of Beta-Cryptoxanthin Produced by Kocuria
Marina DAGII. Mater. Today Proc., 57,
pp.1833–1837.
Çat, J., & Yaman, M., 2019. Determination of
Nicotinic Acid and Nicotinamide Forms of
Vitamin B3 (Niacin) in Fruits and Vegetables
by HPLC Using Postcolumn Derivatization
System. Pakistan J. Nutr., 18, pp.563–570.
Chaudhary, A., Choudhary, S., Sharma, U., Vig,
A.P., Singh, B., & Arora, S., 2018. Purple
Head Broccoli (Brassica oleracea L. var.
Italica Plenck), a Functional Food Crop for
Antioxidant and Anticancer Potential. J.
Food Sci. Technol., 55, pp.1806–1815.
Cleaver, J.E., Brennan-minnella, A.M., Swanson,
R.A., Fong, K., & Chen, J., 2014.
Mitochondrial Reactive Oxygen Species are
Scavenged by Cockayne Syndrome B Protein
in Human Fibroblasts without Nuclear DNA
Damage. PNAS, 2014, pp.6–11.
Cyrus, A., Kabir, A., Goodarzi, D., & Moghimi, M.,
2015. The Effect of Adjuvant Vitamin C after
Varicocele Surgery on Sperm Quality and
Quantity in Infertile Men: A Double Blind
Placebo Controlled Clinical Trial. Int. Braz J
Urol, 41, pp.230–238.
da Cruz, M.C.R., Perussello, C.A., & Masson, M.L.,
2018. Microencapsulated Ascorbic Acid:
Development, Characterization, and Release

Profile in Simulated Gastrointestinal Fluids.
J. Food Process Eng., 41, pp.1–10.
de Souza, A.V., de Mello, J.M., da Silva Favaro, V.F.,
da Silva, V.F., dos Santos, T.G.F., de Lucca
Sartori, D., & Putti, F.F., 2021. Antioxidant
Activity, Bioactive Compounds, and Agro-
Industrial Quality: Correlations between
Parameters in Fresh and Processed Tomatoes.
J. Food Process. Preserv., 45, pp.1–11.
Ding, R., Jin, Y., Liu, X., Zhu, Z., Zhang, Y., Wang,
T., & Xu, Y., 2016. Characteristics of DNA
Methylation Changes Induced by Traffic-
Related Air Pollution. Mutat. Res.-Genet.
Toxicol. Environ. Mutagen. 796, pp.46–53.
Efrat, M., Stein, A., Pinkas, H., Unger, R., & Birk,
R., 2018. Dietary Patterns are Positively
Associated with Semen Quality. Fertil. Steril,
109, pp.809–816.
Egwurugwu, J.N., Ifedi, C.U., Uchefuna, R.C.,
Ezeokafor, E.N., & Alagwu, E.A., 2013.
Effects of Zinc on Male Sex Hormones and
Semen Quality in Rats. Niger. J. Physiol. Sci,
28, pp.17–22.
El Sheikh, M., Mesalam, A.A., Idrees, M., Sidrat,
T., Mesalam, A., Lee, K.L., & Kong, I.K.,
2020. Nicotinamide Supplementation
During the in Vitro Maturation of Oocytes
Improves the Developmental Competence of
Preimplantation Embryos: Potential Link to
SIRT1/AKT Signaling. Cells, 9, pp.1–19.
Fafula, R.V., Onufrovych, O.K., Iefremova, U.P.,
Melnyk, O.V., Nakonechnyi, I.A., Vorobets,
D.Z., & Vorobets, Z.D., 2017. Glutathione
Content in Sperm Cells of Infertile Men.
Regul. Mech. Biosyst., 8, pp.157–161.
Fatima, P., Begum, N., Ishrat, S., Banu, J., Anway,
S.A., Rolly, S.J., Aziz, I., Rahman, D.,
Hossain, H.B., & Hossain, H.N., 2015.
Zinc Suplementation in Male Infertility.
Bangladesh Journals Online, 8, pp.9–13.
Ferreira, F.S., de Oliveira, V.S., Chávez, D.W.H.,
Chaves, D.S., Riger, C.J., Sawaya, A.C.H.F.,
Guizellini, G.M., Sampaio, G.R., Torres,
E.A.F. da S., & Saldanha, T., 2022. Bioactive
Compounds of Parsley (Petroselinum
crispum), Chives (Allium schoenoprasum L)
and Their Mixture (Brazilian cheiro-verde) as
Promising Antioxidant and Anti-Cholesterol
Oxidation Agents in a Food System. Food
Res. Int., pp.151, pp.1–12.
Fillería, S.G., Nardo, A.E., Paulino, M., & Tironi,
V., 2021. Peptides Derived from the
Gastrointestinal Digestion of Amaranth
11S Globulin: Structure and Antioxidant
Functionality. Food Chem. Mol. Sci., 3, pp.1–
10.
KEMAS 18 (4) (2023) 473-482
Guo, Z., Yang, J., Yang, G., Feng, T., Zhang, X.,
Chen, Y., Feng, R., & Qian, Y., 2022. Effects
of Nicotinamide on Follicular Development
and the Quality of Oocytes. Reprod. Biol.
Endocrinol., 20, pp.1–12.
Haeri, F., Nouri, M., Nezamoleslami, S., Moradi,
A., & Ghiasvand, R., 2022. Role of Dietary
Antioxidants and Vitamins Intake in Semen
Quality Parameters: A Cross-Sectional Study.
Clin. Nutr. ESPEN, 48, pp.434–440.
Hamed, M.A., Akhigbe, T.M., Akhigbe, R.E., Aremu,
A.O., Oyedokun, P.A., Gbadamosi, J.A.,
Anifowose, P.E., Adewale, M.A., Aboyeji,
O.O., Yisau, H.O., Tajudeen, G.O., Titiloye,
M.M., Ayinla, N.F.,& Ajayi, A.F., 2022.
Glutamine Restores Testicular Glutathione-
Dependent Antioxidant Defense and
Upregulates NO/cGMP Signaling in
Sleep Deprivation-Induced Reproductive
Dysfunction in Rats. Biomed. Pharmacother,
148, pp.112765.
Hasanpoor-Azghdy, S.B., Simbar, M., & Vedadhir,
A., 2014. The Emotional-Psychological
Consequences of Infertility Among Infertile
Women Seeking Treatment: Results of a
Qualitative Study. Iran. J. Reprod. Med., 12,
pp.131–138.
Hashemipour, H., Kermanshahi, H., Golian, A.,
& Khaksar, V., 2014. Effects of Carboxy
Methyl Cellulose and Thymol + Carvacrol
on Performance, Digesta Viscosity and
Some Blood Metabolites of Broilers. J. Anim.
Physiol. Anim. Nutr. (Berl), 98, pp.672–679.
Indarwati, I., Budihastuti, U.R., & Dewi, Y.L.R.,
2017. Analysis of Factors Influencing Female
Infertility. J. Matern. Child Heal., 2, pp.150–
161.
Jamalan, M., Ghaffari, M.A., Hoseinzadeh, P.,
Hashemitabar, M., & Zeinali, M., 2016.
Human Sperm Quality and Metal Toxicants:
Protective Effects of Some Flavonoids on
Male Reproductive Function. Int. J. Fertil.
Steril, 10, pp.215–222.
Karra, S., Sebii, H., Jardak, M., Bouaziz, M.A., Attia,
H., Blecker, C., & Besbes, S., 2020. Male Date
Palm Flowers: Valuable Nutritional Food
Ingredients and Alternative Antioxidant
Source and Antimicrobial Agent. South
African J. Bot., 131, pp.181–187.
Ko, E.Y., Sabanegh, E.S., & Agarwal, A., 2014. Male
Infertility Testing: Reactive Oxygen Species
and Antioxidant Capacity. Fertil. Steril., 102,
pp.1518–1527.
Leal, F.C., Farias, F.O., do Amaral, W., Toci, A.T.,
Mafra, M.R., & Igarashi-Mafra, L., 2022.
Green Solvents to Value Annona muricata
480
Sri Winarni, et all. / Types and Sources of Antioxidants that Role in Determining Fertility Level
L. Leaves as Antioxidants Source: Process
Optimization and Potential as a Natural Food
Additive. Waste and Biomass Valorization,
13, pp.1233–1241.
Leontowicz, H., Leontowicz, M., Latocha, P.,
Jesion, I., Park, Y.S., Katrich, E., Barasch,
D., Nemirovski, A., & Gorinstein, S., 2016.
Bioactivity and Nutritional Properties
of Hardy Kiwi Fruit Actinidia arguta in
Comparison with Actinidia deliciosa
“Hayward” and Actinidia eriantha “Bidan.”
Food Chem., 196, pp.281–291.
Liu, Z., Ren, Z., Zhang, J., & Chuang, C., 2018. Role
of ROS and Nutritional Antioxidants in
Human Diseases. Front. Physiol., 9, pp.1–14.
Mahamat, S.A., Niane, K., Cyrille Ayessou, N., Sow,
A., Balde, S., Ibn Khatab Cisse, O., & Coume,
M., 2021. Lycopen’s Stability in Watermelon
Juice (Citrullus lanatus) Regarding to
Technological Routes. Food Nutr. Sci., 12,
pp.693–702.
Majzoub, A., & Agarwal, A., 2017.
Antioxidant Therapy in Idiopathic
Oligoasthenoteratozoospermia. Indian J.
Urol., 33, pp.207–214.
Mardiana, M., Lestari, Y.N., & Prameswari, G.N.,
2022. Quality of Diet and Nutritional Status
on Male Young Athletes in Central Java. J.
Kesehat. Masy., 17, pp.444–452.
McLaughlin, Q.R., & Gunderson, M.P., 2022. Effects
of Selenium Treatment on Endogenous
Antioxidant Capacity in Signal Crayfish
(Pacifastacus leniusculus). Comp. Biochem.
Physiol. Part - C Toxicol. Pharmacol., 256,
pp.1–6.
Miafo, A.P.T., Koubala, B.B., Muralikrishna, G.,
Kansci, G., & Fokou, E., 2022. Non-starch
Polysaccharides Derived from Sorghum
Grains, Bran, Spent Grain and Evaluation of
Their Antioxidant Properties with Respect
to Their Bound Phenolic Acids. Bioact.
Carbohydrates Diet. Fibre, 28, pp.1–7.
Mohamad, S.B., & Hassan, A.A., 2014. Improving
Effect of Zinc Supplementation on Pituitary
Gonadotropins Secretion in Smokers.
African J. Pharm. Pharmacol., 8, pp.81–86.
Mouradov, A., & Spangenberg, G., 2014. Flavonoids:
A Metabolic Network Mediating Plants
Adaptation to Their Real Estate. Front. Plant
Sci., 5, pp.1–16.
Muhammad, Z., 2017. Effects of Dietary Vitamin E
on Male Reproductive System. Asian Pacific
J. Reprod., 6, pp.145–150.
Nishino, A., Yasui, H., & Maoka, T., 2017. Reaction
and Scavenging Mechanism of β-carotene
and Zeaxanthin with Reactive Oxygen
481
Species. J. Oleo Sci., 66, pp.77–84.
Omu, A., Al-Azemi, M.K., Al-Maghrebi, M.,
Mathew, C.T., Omu, F.E., Kehinde, E.O.,
Anim, J.T., Oriowo, M.A., & Memon, A.,
2015. Molecular Basis for the Effects of
Zinc Deficiency on Spermatogenesis: An
Experimental Study in the Sprague-dawley
Rat Model. Indian J Urol, 31, pp.57–64.
Palani, A.F., 2018. Effect of Serum Antioxidant
Levels on Sperm Function in Infertile Male.
Middle East Fertil. Soc. J., 23, pp.19–22.
Palmieri, M., Papale, P., Della Ragione, A., Quaranta,
G., Russo, G., & Russo, S., 2016. In Vitro
Antioxidant Treatment of Semen Samples in
Assisted Reproductive Technology: Effects of
Myo-inositol on Nemaspermic Parameters.
Int. J. Endocrinol., 2016, pp.1–5.
Panyayong, C., Srikaeo, K., 2022. Foods from
Banana Inflorescences and Their Antioxidant
Properties: An Exploratory Case in Thailand.
Int. J. Gastron. Food Sci., 28, pp.1–6.
Pastore, L.M., Karns, L.B., Ventura, K., Clark,
M.L., Steeves, R.H., & Callanan, N.,
2014. Longitudinal Interviews of Couples
Diagnosed with Diminished Ovarian
Reserve Undergoing Fragile X Premutation
Testing. J. Genet. Couns., 23, pp.97–107.
Pereira, P.M. de C.C., & Vicente, A.F. dos R.B., 2013.
Meat Nutritional Composition and Nutritive
Role in the Human Diet. Meat Sci., 93,
pp.586–592.
Perez, M.B., Da Peña Hamparsomian, M.J.,
Gonzalez, R.E., Denoya, G.I., Dominguez,
D.L.E., Barboza, K., Iorizzo, M., Simon, P.W.,
Vaudagna, S.R., & Cavagnaro, P.F., 2022.
Physicochemical Properties, Degradation
Kinetics, and Antioxidant Capacity of
Aqueous Anthocyanin-Based Extracts from
Purple Carrots Compared to Synthetic and
Natural Food Colorants. Food Chem., 387,
pp.1–13.
Polumackanycz, M., Wesolowski, M., & Viapiana,
A., 2021. Morus alba L. and Morus nigra
L. Leaves as a Promising Food Source of
Phenolic Compounds with Antioxidant
Activity. Plant Foods Hum. Nutr., 76, pp.458–
465.
Rusiani, E., Junaidi, S., Subiyono, H.S., &
Sumartiningsih, S., 2019. Suplementasi
Vitamin C dan E untuk Menurunkan Stres
Oksidatif Setelah Melakukan Aktivitas
Fisik Maksimal. Media Ilmu Keolahragaan
Indonesia. 9, pp.32–37.
S, K., P, H., & Malik, A., 2022. Chlorella Minutissima
as a Functional Food: Evaluation on
Nutritional Profile and Antioxidant Potential

of the Metabolites. Biomass Convers.
Biorefinery., 1, pp.1–13.
Sahin, N., Delibas, I.B., Isaoglu, U., Suleyman, B.,
Yazici, G.N., Coban, T.A., Uzel, K., Suleyman,
H., & Arslan, V., 2022. The Effect of Carvacrol
on Oxido-Inflammatory Ovarian Injury and
Infertility Induced by Ischemia-Reperfusion
in Rats. Clin. Exp. Obstet. Gynecol., 49, pp.1–
10.
Shahraki, M.R., Forghani, T., Mohammadi, M., &
Khazaei-Feizalabad, A., 2015. The Effect of
Intraventricular Administration of Zinc on
Serum LH, FSH, Prolactin, and Testosterone
in Male Rats. Zahedan J. Res. Med. Sci., 17,
pp.1–5.
Sharma, P., Kaur, P., Ghanghas, P., Kaur, J., &
Kaushal, N., 2020. Selenium Ameliorates
Ibuprofen Induced Testicular Toxicity
by Redox Regulation: Running Head: Se
Protects against NSAID Induced Testicular
Toxicity. Reprod. Toxicol., 96, pp.349–358.
Silberstein, T., Har-Vardi, I., Harlev, A., Friger, M.,
Hamou, B., Barac, T., Levitas, E., & Saphier,
O., 2016. Antioxidants and Polyphenols:
Concentrations and Relation to Male
Infertility and Treatment Success. Oxid.
Med. Cell. Longev., 2016, pp.1–6.
Singhal, P., Satya, S., & Naik, S.N., 2021. Fermented
Bamboo Shoots: A Complete Nutritional,
Anti-Nutritional and Antioxidant Profile of
the Sustainable and Functional Food to Food
Security. Food Chem. Mol. Sci., 3, pp.100041.
Šola, I., Stipaničev, M., Vujčić, V., Mitić, B., Huđek,
A., & Rusak, G., 2018. Comparative Analysis
of Native Crocus Taxa as a Great Source of
Flavonoids with High Antioxidant Activity.
Plant Foods Hum. Nutr., 73, pp.189–195.
Talebi, S., Arab, A., & Sorraya, N., 2021. The
Association Between Dietary Antioxidants
and Semen Parameters: A Cross-Sectional
Study Among Iranian Infertile Men. Biol.
Trace Elem. Res., 2021, pp.1–8.
Tkaczewska, J., Zając, M., Jamróz, E., & Derbew,
H., 2022. Utilising Waste from Soybean
Processing as Raw Materials for the
Production of Preparations with Antioxidant
Properties, Serving as Natural Food
Preservatives - A Pilot Study. Lwt, 160, pp.1–
10.
Wang, S., Wang, M., Zhang, S., & Zhao, L., 2014.
Oxidative Stress in Rats with Hyperhomo-
Cysteinemia and Intervention Effect of
Lutein. Eur. Rev. Med. Pharmacol. Sci., 18,
pp.359–364.
Wijayanti, I., & Setiyorini, E.S.S., 2018. Nutritional
Content of Wild and Cultured Eel (Anguilla
KEMAS 18 (4) (2023) 473-482
bicolor) from Southern Coast of Central Java.
ILMU Kelaut. Indones. J. Mar. Sci., 23, pp.37.
Wiweko, B., Anggraheni, U., Elvira, S.D., &bLubis,
H.P., 2017. Distribution of Stress Level
Among Infertility Patients. Middle East
Fertil. Soc. J., 22, pp.145–148.
Wu, S., Wang, M., Deng, Y., Qiu, J., Zhang, X., &
Tan, J., 2020. Associations of Toxic and
Essential Trace Elements in Serum, Follicular
Fluid, and Seminal Plasma with In Vitro
Fertilization Outcomes. Ecotoxicol. Environ.
Saf., 204, pp.110965.
Yan, L., Liu, J., Wu, S., Zhang, S., Ji, G., & Gu, A.,
2014. Seminal Superoxide Dismutase Activity
and Its Relationship with Semen Quality and
SOD Gene Polymorphism. J. Assist. Reprod.
Genet., 31, pp.549–554.
Zapata-Londoño, M.B., Ramos Polo, A., Alzate-
Arbelaez, A.F., Restrepo-Betancur, L.F.,
Rojano, B.A., & Maldonado-Celis, M.E.,
2020. Effect of Mango (Mangifera indica)
cv. azÚcar Juice Consumption on Plasma
Antioxidant Capacity and Oxidative Stress
Biomarkers. Vitae, 27, pp.1–10.
Zareba, P., Colaci, D.S., Afeiche, M., Gaskins, A.J.,
Jørgensen, N., Mendiola, J., Swan, S.H.,
& Chavarro, J.E., 2013. Semen Quality in
Relation to Antioxidant Intake in a Healthy
Male Population. Fertil. Steril., 100, pp.1572–
1579.
Zhang, Q., & Yang, G., 2014. Selenium Speciation
in Bay Scallops by High Performance Liquid
Chromatography Separation and Inductively
Coupled Plasma Mass Spectrometry
Detection After Complete Enzymatic
Extraction. J. Chromatogr. A., 1325, pp.83–
91.
Zhao, C., Miao, Z., Yan, J., Liu, Jing, Chu, Z., Yin,
H., Zheng, M., & Liu, J., 2022. Ultrasound-
induced Red Bean Protein–lutein Interactions
and Their Effects on Physicochemical
Properties, Antioxidant Activities and
Digestion Behaviors of Complexes. Lwt, 160,
pp.1–10.
Zhao, J., Dong, X., Hu, X., Long, Z., Wang, L., Liu,
Q., Sun, B., Wang, Q., Wu, Q., & Li, L., 2016.
Zinc Levels in Seminal Plasma and Their
Correlation with Male Infertility. Sci. Rep., 6,
pp.1–10.
Zhao, R.N., Yuan, Y., Liu, F., Han, J.G., & Sheng, L.,
2013. A Computational Investigation on the
Geometries, Stabilities, Antioxidant Activity,
and the Substituent Effects of the L-ascorbic
Acid and Their Derivatives. Int. J. Quantum
Chem., 113, pp.2220–2227.
482